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In the past year, a lot of progress has been made in the field of lymphoma, and many clinical trials are in full swing, bringing good news
01
Professor Song Yuqin: Lymphoma is not a particularly common type of disease in China, China's 2020 lymphoma statistics show that Hodgkin lymphoma new cases of 6829 cases, non-Hodgkin lymphoma 92834 cases
Compared with Japan, South Korea and Europe and the United States, the overall survival status of Chinese patients ranks in the third echelon, Europe and the United States relatively have a long survival period and a high cure rate, followed by Japan and South Korea, and China is relatively unsatisfactory
Some disease types have a poor
The diagnosis and treatment of lymphoma at the primary level is insufficient
Supportive care for lymphoma is also important, and whitening prevention and anti-infective therapy are also important parts
02
Physician's Journal: Which lymphomas are ascertained and allogeneic hematopoietic stem cell transplantation suitable for? What experiences do you have with the prevention of GVHD?
Prof.
Xiaoxiong Wu: Auto-HSCT is suitable for: (1) advanced or relapsed/refractory Hodgkin lymphoma, (2) advanced or recurrent/refractory diffuse large B-cell lymphoma, Burkitt and other invasive lymphomas, (3) follicular lymphoma that relapses or converts to large B cells, (4) socket lymphoma with relapsed or late staging, and (5) peripheral T-cell lymphoma
.
Allo-hematopoietic stem cell transplantation (Allo-HSCT) is indicated for younger chronic lymphocytic leukemia (CLL) with (1) 17p/11q deletion or abnormal mutation of the TP53 gene, failure of fludarabine or combination immunotherapy therapy (primary resistance or pfs< 12-24 months); (2) Relapsed/ refractory or auto-HSCT after recurrence or transformation into aggressive follicular lymphoma; (3) Diffuse large B-cell lymphoma and strobe lymphoma that recur at high risk of recurrence/refractory or bone marrow/multi-site involvement of the whole body or recurrence after Auto-HSCT; (4) Some highly aggressive malignant lymphomas, such as lymphoblastoma/leukemia (LBL), hepatosplenocyte lymphoma, aggressive relapsed/refractory peripheral T-cell/NK-cell lymphoma and adult T-cell leukemia/lymphoma, as well as various types of NHL
that relapse after Auto-HSCT.
(5) Relapsed/refractory and Recurrent Hodgkin lymphoma
after Auto-HSCT.
Graft-versus-host disease (GVHD) refers to a disease
in which a series of symptoms occur after allogeneic hematopoietic stem cell transplantation due to the donor's T lymphocytes attacking multiple tissues and organs of the recipient.
GVHD occurs early after transplantation called acute GVHD (aGVHD) and 100 days later is called chronic GVHD
.
There are several ways to prevent the occurrence of aGVHD:
1.
Donor selection: Try to choose fellow donors, young donors, and male donors
with HLA.
2.
Full environmental protection before transplantation: live in laminar flow wards, sterile diet, skin cleaning and disinfection and oral antibiotics to reduce (intestinal) infection
.
3.
Pretreatment: Adopt a reduced dose (or fractional TBI radiotherapy) pretreatment regimen
.
4.
Drug prophylaxis: mainly cyclosporine, methotrexate, snapdragon, adrenocorticosteroids (controversial), tacrolimus, etc
.
5.
T cell removal (inhibition) method: (1) commonly used anti-thymic cell globulin (ATG), anti-interleukin 2 (IL-2) receptor monoclonal antibody (CD25 monoclonal antibody), etc.
; (2) In vitro de-T cell method; The failure rate and recurrence rate of this method have increased after transplantation, and it is rarely used
at present.
6.
Others: Mesenchymal stem cells and third-party cord blood cells may also reduce the occurrence
of aGVHD.
03
Physician's Report: For elderly patients who cannot tolerate the intensity of standard treatment, how to standardize the reduction treatment?
Professor Liu Hui: For elderly lymphoma patients how to determine whether they can tolerate standard doses of chemotherapy, according to what standard reduction is a very important clinical issue, we take the most common type of lymphoma diffuse large B cell lymphoma (DLBCL) as an example, DLBCL although invasive lymphoma, but can be cured, the standard first-line treatment is R-CHOP protocol, so that about 50% of patients to achieve cure
.
However, about 40% of elderly lymphoma patients cannot tolerate the standard dose of R-CHOP regimen due to poor constitution or comorbidities, and often require reduced dose therapy
.
It is recommended to determine whether it can tolerate standard therapeutic doses
based on the comprehensive assessment of geriatrics (CGA).
CGA is a comprehensive assessment around the living ability of the elderly, the degree of chronic diseases, the functional state of the organs, etc.
, which can comprehensively and objectively reflect the tolerance of elderly DLBCL patients to chemotherapy
, and CGA achieves the tolerance of chemotherapy to elderly DLBCL patients through quantitative scoring scales.
However, the overall efficacy of reduced dose patients is worse than that of patients treated with standard doses, but if these patients are forced to give standard doses of chemotherapy, the efficacy can not be improved, and the toxic side effects will increase
.
Therefore, appropriate stratified treatment based on comprehensive geriatric assessment is extremely important
.
The development of new targeted drugs and non-chemotherapy treatments for immunotherapy provides more treatment options for elderly lymphoma patients, and also significantly improves the prognosis, but new targeted drugs and immunotherapy also have their corresponding adverse reactions, such as BTK inhibitors show very good efficacy in the treatment of multiple lymphomas, but BTK inhibitors have bleeding, atrial fibrillation, hypertension and other side effects, because elderly patients often have hypertension and other underlying diseases, so they should be closely monitored when using; In addition, elderly patients take more drugs because of underlying diseases, and some drugs will affect the metabolism of new targeted drugs, so please ask a clinical pharmacist for guidance
before treatment.
04
Physician's Daily: CAR-T treatment is a hot topic in the current research, please tell us about the current CAR-T treatment of lymphoma for which groups? Is it expected to be used more frontline?
Professor Jing Hongmei: CAR-T cell therapy is one of the cellular immunotherapy methods, following surgery, chemotherapy, radiotherapy, the biggest breakthrough in blood tumors is CAR-T treatment
.
In the field of expression of CD19 antigen, China has two products on the market, after the listing of China, there are also patients to try, the efficacy is better, at the same time in the third hospital of Beijing Medical University there are also related clinical trials in doing, patients during the clinical trial also benefit
.
The current commercialization of CAR-T has also brought good news to patients, and its approved indications are mainly concentrated in DLBCL, including refractory relapse of DLBCL, primary mediastinal B-cell lymphoma, follicular transformation DLBCL, in addition to DLBCL, sleeve cell lymphoma (MCL), follicular lymphoma also have CD19 CAR-T in clinical research
.
Patients with CD19 expression on tumor cells can be treated
in this way.
At this stage, CAR-T treatment of lymphoma is used in the back line therapy, such as refractory relapsed DLBCL patients
.
Some scholars have proposed to use CAR-T in first-line treatment, and currently clinical studies use CAR-T more
in second-line treatment.
CAR-T is used in the first line and still requires special caution, and 60% of patients with DLBCL can be cured
by conventional chemotherapy.
In the future, patients need to be effectively stratified to determine that they will not benefit from chemotherapy, and CAR-T therapy may be considered to address clinical dilemmas and provide patients with new treatment options
.
05
Physician's Daily: In the era of new drugs, what are the challenges facing lymphoma diagnosis and treatment? In terms of immunotherapy, what research progress can improve the survival of patients is worth paying attention to?
Professor Zhang Wei: Diffuse large B-cell lymphoma is the most common type of invasive lymphoma in China, accounting for 40-50%.
The marketing of rituximab in 1998 set off the prelude to immunochemotherapy, but under the RCHOP induction therapy, 40% of patients are still not cured
.
In recent years, there has been more consensus on the biological characteristics and genotyping of DLBCL, and new drugs have also empowered lymphoma doctors, and the survival of DLBCL is expected to break through the bottleneck
.
New drugs mainly include several aspects: 1.
Small molecule targeted drugs such as BTK inhibitors Pi3K inhibitors, BCL2 inhibitors, nuclear output protein inhibitors, EZH2 inhibitors, etc.
; 2.
Monoclonal antibodies, new targets such as Tafasitamab acting on CD19, antibody-coupled drugs such as Pola acting on CD79b-coupled MMAE, Loncastuximab Tesirine acting on the cytotoxin of CD19-coupled pyrroleb(PBD)dimer; Bispecific antibodies, CD3+ CD20 double anti-Mosunetuzumab, Glofitamab, Odronextamab, Epcoritamab; 3.
Cell therapy CART treatment is also a highlight in the field of tumor treatment in recent years; 4.
Immune checkpoint inhibitors and immunomodulators such as rumanamide, pomardomide
.
In the past decade, the first-line RCHOP + X/ Y tried to break through the ceiling of RCHOP, at present, only Pola combination therapy has reached the main observation endpoint PFS, bispecific antibodies are also making the same attempt, refractory recurrence DLBCL We ushered in two new FDA approved programs Pola +BR and tafa combined with lenalidomide, both achieved better short- and long-term efficacy than previous traditional chemotherapy, THE LONGEST CART CURRENTLY FOLLOWED ZUMA1 STUDY WITH 42%
OF 5-YEAR OSIS IN PATIENTS OF R/R DLBCL WHO HAD PREVIOUSLY HAD A MEDIAN SURVIVAL OF TRADITIONAL SALVAGE CHEMOTHERAPY FOR ONLY HALF A YEAR.
In the future, how to accurately personalize the treatment of DLBCL patients needs to be explored for a long time, and the best combination between first-line high-risk patients combining corresponding targeted drugs, cell therapy preposition, and new targeted drugs according to tumor driver genes will be the future research direction
.
Expert Profiles
Professor Song Yuqin
Chief physician, professor, doctoral supervisor
Vice President of Peking University Cancer Hospital, Deputy Director of the Department of Lymphoma
Director of the Chinese Society of Clinical Oncology (CSCO).
Secretary-General of the Anti-Lymphoma Expert Working Committee of the Chinese Society of Clinical Oncology (CSCO).
Chairman of the Lymphatic Hematology and Tumor Professional Committee of Beijing Anti-Cancer Association
Chairman of the Lymphoma Professional Committee of the Chinese Health Promotion Association
Member of the Standing Committee of the Oncology and Hematology Professional Committee of the Chinese Anti-Cancer Association
Member of the Standing Committee of the Blood Immunology Branch of the Chinese Society of Immunology
He has conducted postdoctoral basic research at Peking University Health College and studied clinical diagnosis and treatment of lymphoma in the United States
He has undertaken 5 projects of the National Natural Science Foundation of China Youth Fund and surface projects, a major special sub-project of the Ministry of Science and Technology, a provincial outstanding young and middle-aged scientist fund and a project of the Beijing Municipal Natural Science Foundation; He has published more than 50 SCI papers and 3 academic monographs
.
Expert Profiles
Professor Wu Xiaoxiong
Doctor of Medicine, Chief Physician/Professor, Graduate Supervisor, Director of the Department of Hematology, Fourth Medical Center of PLA General Hospital
Member of the Medical Staff Committee of the Hematology Professional Committee of the Whole Army
Member of the Blood Disease Transformation Committee of the Chinese Anti-Cancer Association
Member of the Standing Committee of the Lymphatic Hematology and Tumor Professional Committee of the Chinese Gerontology and Geriatrics Association
Vice Chairman of the Geriatric Comprehensive Assessment Committee of the Hematology Branch of the Chinese Geriatrics Association
Member of the Hematology and Tumor Professional Committee of the Chinese Anti-Cancer Association
Director
of Hematology Branch of Beijing Medical Doctor Association.
He is the chief editor of 4 monographs on hematology and 8 related monographs
.
Undertake 3 projects of 863 projects, 1 project of the Capital Special Fund, and 4 scientific and technological projects of the whole army; He has participated in many national and military projects
.
He has won 2 second prizes for scientific and technological progress of the whole army and 3 third prizes for scientific and technological progress of the
whole army.
He has published more than 150 papers in domestic and foreign journals
Expert Profiles
Liu Hui Chief Physician
Chief Physician Doctoral Supervisor
Director of the Department of Hematology, Beijing Hospital
Member of the Hematology Branch of the Chinese Medical Doctor Association
Member of the Red Blood Cell Group of the Hematology Branch of the Chinese Medical Association
Member of the Standing Committee and Deputy Director General of the Hematology Branch of the Chinese Geriatrics Association
Member of the China Anti-Lymphoma Alliance
Member of the Standing Committee of the Oncology Committee of the Chinese Association of Women Physicians
Member of the Hematology Branch of the Beijing Medical Association
Standing Director of Hematology Branch of Beijing Medical Doctor Association
Vice Chairman of the Hematology Branch of Integrative Traditional Chinese and Western Medicine of Beijing Medical Association
Corresponding editorial board member of chinese journal of hematology
Member of the editorial board of Leukemia, Lymphoma, Journal of Clinical Drug Therapy
Expert Profiles
Jing Hongmei Chief Physician
Director of the Department of Hematology, Peking University Third Hospital
Chief physician, professor, doctoral supervisor
Chairman of the Hematology and Tumor Committee of the Beijing Society of Integrative Medicine
Vice Chairman of the Blood Professional Committee of Beijing Perioperative Medical Research Association
Vice Chairman of the Oncology Expert Committee of the Chinese Association of Women Physicians
Vice Chairman of the Lymphoma Committee of China Medical Education Association
Vice Chairman of the Youth Committee of the Blood Branch of the China Medical Education Association
Member of the Standing Committee of the Geriatric Oncology Professional Committee of the Chinese Gerontological Society
Member of the Diagnostics Group of the Blood Branch of the Chinese Medical Association
Member of the Blood Branch of the Chinese Medical Doctor Association
Specialty: Tumors of the lymphatic system
Expert Profiles
Professor Zhang Wei
Chief Physician Master Supervisor
Youth Committee member of Chinese Geriatric Lymphoma Society
Hematology and Tumor Professional Committee Member of China Anti-Cancer Association
Member of the Blood Immunology Branch of the Chinese Society of Immunology
Member of the Standing Committee of the China Anti-Lymphoma Alliance
Secretary of the Hematology Expert Committee of Beijing Medical Reward Foundation Graduated from Guangzhou Sun Yat-sen Medical University in 1995 for clinical medicine
In August 1995, he entered the Department of Internal Medicine of Peking Union Medical College Hospital
He began his career in hematology in 2000
In 2002, he obtained a master's degree from Peking Union Medical College of China
He specializes in lymphoma and hematopoietic stem cell transplantation
He has mainly participated in the presidency of a number of surfaces, capital characteristics, Beijing Natural Science Foundation, as the first or corresponding author to write more than 60 SCI and core journals, and participated in the compilation of "Lymphoma", "Concord Hematology" and other works
8 special trains from 4 places in the north to Guangzhou and Hangzhou have set sail! The train will carry 1220 public welfare touring exhibition posters including 22 academicians/ Chinese medicine masters/ national famous Chinese medicine doctors, 145 hospital management experts, and 1582 medical elites, including academician Zhong Nanshan, for a one-month tour exhibition, which will "close contact" with more than 200 million passengers! At the same time, the total video of the poster will be broadcast in turn on the 13,000 TVs covering the subway and platforms on the Beijing 1, 2, 5, 8, 13 and Batong lines every day, and it is expected that more than 100 million views will be viewed!
Highlights of the public welfare touring exhibition activities:
Public Welfare Tour Exhibition Activities Wonderful Article Review: Tribute to Chinese Doctors' Day • Healthy China You and I Go Together 59 | President Cai Xiujun: Innovative Power Source Building a World-class Modern Hospital To Salute Chinese Doctors Day • Healthy China You and I Walk 58 | President Zhang Shutian: I want to take this "road" to "bright" to pay tribute to Chinese Doctors' Day • Healthy China You and I walk together 57 | Professor Tang Yida's team: technology-driven, multidisciplinary collaboration, and the construction of a full-life cycle health management system salute China Physicians' Day • Healthy China You and I walk together for 56 | Break through the forbidden zone! The perioperative multidisciplinary team of advanced surgery protects the well-being of patients
Typography: Hu Haiyan
Editor: Lina Wang
Review: Lina Wang
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